The Cost of Smoking: Puffing a Way Deeper Into Poverty

http://thejakartaglobe.com/home/the-cost-of-smoking-puffing-a-way-deeper-into-poverty/277648


To call the neighborhood of Muara Angke in North Jakarta a slum is an understatement. There has to be a whole new definition for the cramped, run-down, stilted houses that stand on the ankle-high, sometimes higher, water seeping in from the nearby Kali Adem River.

The dank and filthy water is still used for bathing and to wash dishes and clothes. The stifling smell of garbage and rotting fish fills the air.

People here work as fishermen or laborers, earning no more than Rp 50,000 (about $5) a day. It is hard just to get by, but even still, the men seem to have no shortage of cigarettes. It is an alarming fact here and elsewhere among people living in poverty: Men spend their money on cigarettes rather than food for their families.

Suleha, 28, a mother of four and occasional worker at a nearby fish market, says she is frustrated that her husband, Abdul Muthalib, spends half of his daily income, or more, on cigarettes.

Abdul works different odd jobs, including assisting fishermen and laboring in the market, pulling in Rp 30,000 to Rp 60,000 a day. Yet, he also smokes three packs a day, wasting up to Rp 18,000 on cigarettes instead of buying food for his children, who look visibly undernourished.

“Sometimes he can’t find any work and earns absolutely nothing for days. But he still smokes and asks the cigarette seller to allow him to pay for the cigarettes later,” Suleha said during an interview at her house while her husband was out. “When we have money, then we have to use it to pay that debt.”

Suleha said Abdul’s smoking has been a constant source of arguments between them. When she told him that the money could be better used to buy eggs, he barked: “What does it have to do with eggs?”

Suleha sometimes earns money herself by shucking oysters, getting Rp 6,000 per barrel.

“Our eldest son should enroll in junior high school this year, but I’m not sure he’ll be able to continue going to school,” she said. “We don’t have the money to pay the tuition.”

If only Abdul did not smoke, she said, the couple could save Rp 12,000 a day, or Rp 360,000 a month, which is more than enough to pay for the Rp 50,000 monthly tuition.

Suleha’s neighbor, a fisherman named Ilyas, is a smoker and says it is hard to quit — even if it means his son Zainudin, 14, can only go to a local alternative school for poor students that does not even award completion certificates.

Indonesia is home to some 63 million smokers, according to 2006 figures from the Central Statistics Agency (BPS). According to the agency, on average, households with at least one smoker spend Rp 117,624 a month on cigarettes.

Indonesia joined 167 other countries in signing the World Health Organization’s Framework Convention on Tobacco Control in Geneva in 2004, but remains one of only four nations that have failed to ratify the treaty. The treaty’s stated goal is to “protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke.”

Antismoking activists have urged the government to ratify the treaty, but many officials, notably Industry Minister Fahmi Idris, have rejected their calls, saying that at least 12 million people depend on the cigarette industry for jobs.

Locally conducted research, however, shows that cigarettes actually perpetuate poverty. Among the country’s poorest people, estimated to be about 40 million, or 10 million households, one in every two families have at least one smoker, according to BPS data.

The Demographic Institute at the University of Indonesia’s School of Economics says cigarettes account for 11.89 percent of total expenses among poor families, second only to rice. Among wealthier Indonesians, cigarettes account for 8.33 percent of their total expenses, dropping from second most prioritized commodity to fifth over the past several years.

“There has been a decrease, albeit slightly, among wealthy smokers,” Abdillah Ahsan, a researcher at the Demographic Institute, said about Indonesian consumer habits. “Among the poorest smokers, however, cigarette [purchases] have remained constant between 2003 and 2007.”

Poor households spend on average Rp 56,188 a month, or up to Rp 675,000 a year, on cigarettes, which is 17 times more than what they spend on meat, 15 times more than health care, 9 times more than educational expenses and 5 times more than dairy products.

“Family nutrition is sacrificed for the sake of cigarettes. And then smokers get smoking-related diseases, or die prematurely, leaving the family further trapped in poverty,” Abdillah said.

Dr. Widyastuti Soerojo, head of the Indonesian Public Health Association’s Tobacco Control Support Center, said the Ministry of Health estimated that about 400,000 Indonesians died every year from smoking-related diseases. The health cost burden to the state for treating such patients reached an estimated Rp 167 trillion a year in 2005, five times the annual revenue of cigarette excise taxes.

“Tobacco consumption in developed countries has dropped, but not in developing countries,” said Widyastuti, who is a medical doctor. “There should be a law to regulate cigarette consumption and to prevent new smokers.”

Activists say they lament the opportunities lost by poor families whose incomes are diverted to cigarettes, while the increased death rate from smoking among working-age breadwinners in poor households only serves to perpetuate that poverty.

“The cost for reproductive health is $11 a year per couple, or equal to 15 packs of cigarettes, which is a supply for 7 to 10 days,” Abdillah said. “If every smoking husband could refrain from smoking that much in a year, the money could be allocated for reproductive health costs and help prevent maternal mortality and unwanted pregnancy.”

The country indeed still has the highest maternal mortality rate in Southeast Asia at 262 deaths per 100,000 births, based on 2007 data, and the flagging “two children are enough” national family planning program has resulted in poor people having more children.

Abdillah said the government could reduce the number of smokers among the country’s poor by increasing the cigarette excise tax, which would lead to higher prices per pack.

“My research in 2008 showed that smokers from the poorest populations are susceptible to cigarette price increases,” he said. “A 10 percent increase reduced the number of smokers among poor families by 17 percent, compared to rich families, where it was only a 4 percent decrease.”

Price increases for cigarette packs, he said, would deter non-smokers in poorer populations from being tempted to take up the habit, saving them from the poverty trap.

“Increasing cigarette prices would also reduce the number of deaths and illnesses caused by smoking-related diseases,” Abdillah said. “In the end, it would prevent and reduce poverty by [forcing people] to alter their spending from cigarettes to more important commodities like nutritious food, education and health.”

However, Asep Cahyana, a smoker who lives in the Muara Angke slum, doubted that higher prices would decrease the number of smokers because cheap unbranded cigarettes were still readily available.

In that case, Widyastuti said, there should be other interventions in addition to increased taxes and sale prices, namely intensified antismoking campaigns, a cigarette advertising ban, widespread distribution of illustrated warnings and an increase in smoke-free areas.

Labels: social affairs, Tobacco

Posted by hera at Wednesday, May 27, 2009 3:09 AM | Permalinks